Antiaggregant Drugs Research Articles

Association of Antithrombotic Drug Use With Incident Intracerebral Hemorrhage Location.

Few population-based studies have assessed associations between the use of antithrombotic (platelet antiaggregant or anticoagulant) drugs and location-specific risks of spontaneous intracerebral hemorrhage (s-ICH). In this study, we estimated associations between antithrombotic drug use and the risk of lobar vs nonlobar incident s-ICH. Using Danish nationwide registries, we identified cases in the Southern Denmark Region of first-ever s-ICH in patients aged 50 years or older between 2009 and 2018. Each verified case was classified as lobar or nonlobar s-ICH and matched to controls in the general population by age, sex, and calendar year. Prior antithrombotic use was ascertained from a nationwide prescription registry. We calculated odds ratios (aORs) for associations between the use of clopidogrel, aspirin, direct oral anticoagulants (DOACs) or vitamin K antagonists (VKA), and lobar and nonlobar ICH in conditional logistic regression analyses that were adjusted for potential confounders. A total of 1,040 cases of lobar (47.9% men, mean age [SD] 75.2 [10.7] years) and 1,263 cases of nonlobar s-ICH (54.2% men, mean age 73.6 [11.4] years) were matched to 41,651 and 50,574 controls, respectively. A stronger association with lobar s-ICH was found for clopidogrel (cases: 7.6%, controls: 3.5%; aOR 3.46 [95% CI 2.45-4.89]) vs aspirin (cases: 22.9%, controls: 20.4%; aOR 2.14 [1.74-2.63; p = 0.019). Corresponding estimates for nonlobar s-ICH were not different between clopidogrel (cases: 5.4%, controls: 3.4%; aOR 2.44 [1.71-3.49]) and aspirin (cases: 20.7%, controls: 19.2%; aOR 1.77 [1.47-2.15]; p = 0.12). VKA use was associated with higher odds of both lobar (cases: 14.3%, controls: 6.1%; aOR 3.66 [2.78-4.80]) and nonlobar (cases: 15.4%, controls: 5.5%; aOR 4.62 [3.67-5.82]) s-ICH. The association of DOAC use with lobar s-ICH (cases: 3.5%, controls: 2.7%; aOR 1.66 [1.02-2.70]) was weaker than that of VKA use (p = 0.006). Corresponding estimates for nonlobar s-ICH were not different between DOACs (cases: 5.1%, controls: 2.4%; aOR 3.44 [2.33-5.08]) and VKAs (p = 0.20). Antithrombotics were associated with higher risks of s-ICH, but the strength of the associations varied by s-ICH location and drug, which may reflect differences in the cerebral microangiopathies associated with lobar vs nonlobar hemorrhages and the mechanisms of drug action.

Controversy in cardiology: clopidogrel or acetylsalicylic acid in the treatment of chronic coronary syndromes?

Secondary prevention of patients with chronic coronary syndrome is based on the long-term use of a single anti-aggregating drug which is traditionally represented by acetylsalicylic acid (ASA) in light of the results of studies and meta-analyses which have demonstrated a clear anti-ischaemic efficacy against of an acceptable increase in the risk of bleeding, especially intracranial and gastrointestinal bleeding. The availability of drugs such as clopidogrel, which inhibits platelet activity through the P2Y12 receptor pathway, has called into question this paradigm, also in consideration of the fact that the scientific evidence that supports the use of ASA in secondary prevention is based on dated studies with some limitations. Over the last few years, randomized trials have demonstrated how clopidogrel has an efficacy profile comparable to that of ASA and a safety profile that is sometimes even better. In light of the new evidence, it is therefore legitimate to ask whether in this clinical scenario, ASA should still be considered the drug of choice or whether clopidogrel could represent the preferable alternative.

Diş Hekimlerinin Antiagregan ve Antikoagülan İlaçlar Hakkındaki Bilgi Düzeyinin Değerlendirilmesi

Objective: Many of the treatments of dentists consist of treatments with bleeding risk. Patients using antiaggregant/anticoagulant drugs are at risk of prolonged bleeding during the perioperative period in various dental procedures. On the other hand, the use of these agents is also necessary for the maintenance of the general medical health of the patient. In this study, it was aimed to measure the knowledge level of dentists about antiaggregant and anticoagulant drugs, and also to evaluate the effect of gender, institution, working period and title on this level of knowledge.
 Method: The research was planned as a descriptive survey study. The questionnaire was delivered to a total of 200 people, including dentists in Elazig, senior students of the Faculty of Dentistry of Fırat University, assistants and lecturers. 157 participants who agreed to answer the form were included in the study. Data were expressed as numbers and percentages.
 Results: 41.4% of the dentists stated that they encountered patients using antiaggregant/anticoagulant very frequently. The rate of physicians who considered themselves to have sufficient knowledge about these drugs was 42.04%, and the rate of physicians who considered themselves adequate about the treatment to be performed in case of bleeding problems was 36.94%. It was observed that the rate of dentists who said that they had sufficient information about which drug should be discontinued and when was 29.3%. To the question of which drug is an antiaggregant or anticoagulant, 56.05% of the physicians gave the correct answer for heparin, 60.06% for aspirin, 70.7% for warfarin and 46.05% for clopidogrel.
 Conclusion: As a result of our study, it was seen that there is no comprehensive and standardized treatment protocol in our country yet. It has been observed that most of the dentists do not have enough knowledge about antiaggregant and anticoagulant drugs, so they turn to different treatment options. Gender, institution, duration of employment and title; It has been observed that there is a significant effect on the level of knowledge about antiaggregant and anticoagulant drugs.

Discrepancies between clinical and pathological findings seen at renal biopsy in rheumatological diseases.

Renal biopsy contributes to the diagnosis, follow-up, and treatment of many rheumatic conditions. This study assessed the diagnostic role and safety of renal biopsies in a tertiary rheumatology clinic. Renal biopsies performed between June 2020 and December 2022 were screened, and demographic, clinical, histopathological, and safety data were collected from patient records. In this study, 33 males and 38 females were included. Except for 1 patient who received acetylsalicylic acid, antiaggregant, and/or anticoagulant drugs were stopped before the biopsy. Complications included a decrease of hemoglobin in 8 patients (11.3%) and microscopic hematuria in 40 patients (56.3%). Control ultrasonography was performed in 16 patients (22.5%), and a self-limiting hematoma was found in 4 of them (5.6%) without additional complications. While less than 10 glomeruli were obtained in 9 patients (9.9%), diagnosis success was 94.4%. Histopathological data were consistent with one of the pre-biopsy diagnoses in 54 of 67 cases (80.6%) but showed discrepancies in 19.4% (n=13) of patients. A repeat biopsy was performed in 7 patients for re-staging or insufficient biopsy. Renal biopsy significantly contributes to rheumatology practice, especially in patients with complex clinical and laboratory findings or in whom different treatments can be given according to the presence, severity, and type of renal involvement. Although the possibility of obtaining insufficient tissue and the need for re-staging and repeat biopsy in the follow-up might be expected, complication risk does not seem to be a big concern. Renal biopsy often evidenced discrepancies between pre-biopsy diagnosis and histopathological findings.

Potential drug-drug interactions in adults receiving oral anticoagulant and antiaggregant therapy

ABSTRACT Background Anticoagulant and antiaggregant drugs are drug groups with high mortality and the most common cause of malpractice. Research design and Methods 18 and 65 years were scheduled for pharmacotherapy in the Family Health Center. 122 patients during their anticoagulant and/or antiaggregant treatment were evaluated in terms of drug-drug interactions. Results Drug-drug interactions were detected in 89.7% of the patients included in the study. A total of 212 drug-drug interactions were found in 122 patients. Of these, 12 (5.6%) were identified as A, 16 (7.5%) B, 146 (68.6%) C, 32 (15.2%) D and 6 (2.8%) X risk category. The number of DDI was found to be significantly higher in patients aged between 56 and 65 years. The most drug interactions are significantly higher in the C and D categories, respectively. The most predicted clinical outcomes of DDI’s were increased in the therapeutic effect and adverse/toxic reactions. Conclusions Contrary to expectations, it is seen that although polypharmacy is relatively less in patients aged 18–65 years compared to patients over 65 years of age, it is very important to detect drug interactions in this age group in terms of safety, efficacy and treatment benefit in terms of drug-drug interaction.

Efficacy of Burrhole Craniostomy in Chronic Subdural Hematoma. A Retrospective 9-Year Study

Objective: To demonstrate the effectiveness, possible complications, and difference of Burr-hole craniostomy surgical technique applied to patients diagnosed with chronic subdural hematoma from other surgical techniques. Methods: The surgical techniques and postoperative clinical and radiological details of 36 patients who were operated on with the diagnosis of chronic subdural hematoma in the Neurosurgery Clinic of Ordu University Training and Research Hospital between 01.01.2013 and 15.08.2022 were retrospectively analyzed. In all patients in the post-op period, control brain CT was taken within the first 24 hours and compared with the pre-op CT. Again, at the end of post-op 1st, 2nd week and 1st month, control brain CT was taken for all patients and GCS was compared with pre-op scores. After determining the post-op complications, the treatment and results of these complications were examined. Results: One patient who was operated on with Burr-Hole developed motor dysphasia in the post-op period, and intraparenchymal hemorrhage was detected in the post-op tomography of this patient. . Post-op clinical and radiological results of patients who underwent burr-hole craniostomy were significantly better than pre-op clinical and radiological results, and the recurrence rate was low, consistent with the literature. All drains placed in the subdural area after the burr hole opened during the operation were removed before discharge. Conclusions: Although the drainage of chronic subdural hematoma with bur-hole craniostomy has a higher recurrence rate compared to the craniotomy method, it has a lower complication rate and is a more easily applicable surgical technique. In our study, some important points about patients who underwent burrhole craniostomy for cSDH evacuation were highlighted. It was observed that our patients who underwent burrhole craniostomy had higher reoperation rates compared to our patients who underwent craniotomy. We think that the presence of residual hematoma in the controls performed with CT in the post-op period should not be the sole criterion for re-operation. We think that CT controls are sufficient if there is improvement in the neurological status of the patient and a better GCS score in the post-op follow-up.

Synthesis of 12-quinoline substituted andrographolide derivatives and their preliminary evaluation as anti-aggregation drugs

Based on the structure of the natural product andrographolide, a series of novel 12-quinoline substituted derivatives 9 were designed and synthesized. In preliminary biological evaluation, these synthesized compounds showed prominent anti-platelet aggregation activities in response to thrombin and adenosine diphosphate (ADP) agonists. Among them, compound 9o (inhibition rate 55.73%, IC50 0.36 µM/L) had the highest anti-platelet aggregation activity induced by ADP. Compound 9q (inhibition rate 54.31%, IC50 0.30 µM/L) showed the highest anti-platelet aggregation activity induced by thrombin. Most of the derivatives had no significant cytotoxicity. Our research results provide a novel candidate drug structure for anti-platelet aggregation and enrich the scope of application of andrographolide derivatives.

PS-C28-10: HYPERTENSIVE CARDIOMYOPATHY AS MOST FREQUENT ECHOCARDIOGRAPHIC FINDING IN PATIENTS HOSPITALIZED FOR ISCHEMIC STROKE.

Objective: In Spain occurs about 120,000 strokes per year. Initial study usually requires echocardiography to rule out cardioembolic source. We describe most common echocardiographic features in neurological patients and traditional risk factors in them. Methods: From August 2020 to August 2021, 502 consecutive Neurology echocardiograms were analysed, collecting data in SPSS for subsequent descriptive and analytical statistical analysis. Results: 45% were women. Most frequent study reason was ischemic stroke (66%), followed by transient ischemic attack (TIA) (11%), haemorrhagic stroke (2%) and miscellaneous (fever, cardiac enzyme release, dyspnoea, coma) (15%). Highest frequent risk factor was hypertension (HBP) (70%), followed by obesity (51%), dyslipidaemia (46%), diabetes (32%), and kidney failure (15%). Atrial fibrillation (AF) had been documented in 13%, while De novo AF was discovered in an additional 14.5%. Systemic inflammation disorders were present in 19% and hypercoagulability in 9%. 10% had suffered a previous stroke (90% ischemic), and 2.6% TIA. About treatment 27% had antiaggregation drugs on stroke moment and 12% were anticoagulated (5.6% VKA and 6.6% DOAC). In echo images, absence of structural heart disease was the most frequent finding (49%), followed by LA dilatation (48%) and ventricular hypertrophy > 13 mm (34%), both characteristic of hypertensive heart. 5% showed valve disease (more frequent mitral regurgitation) and 5% Cor pulmonale. Cardiomyopathy was found in 3% (Dilated 2.6%). Patent foramen ovale, and aneurysm of the interatrial septum were rare (1% each). Ostium secundum type ASD only one case (0.2%). In the follow-up 5% had a new event (stroke or TIA) in next 12 months and additional 4.4% evidence of AF was found, this variable being related to left atrial dilatation in statistical analysis. Conclusions: In our sample of patients with ischemic stroke the abnormal finding most recurrent was hypertensive heart disease (HBP, LA dilatation, and LVH). LA dilation was related to the development of AF during follow-up, this relationship being statistically significant (p < 0.001) by chi-square test. The percentage of de novo AF discovered in the same stroke episode (14.5%) is noteworthy. The ineffectiveness of antiaggregation (27% took it) and that anticoagulation does not completely eliminate risk either. Presence of structural anomalies such ASD, PFO or thrombus was rare (less than 1%).

Digital Health Interventions in Patient Management Following Acute Coronary Syndrome: A Meta-Analysis of the Literature.

Acute coronary syndrome patients should be closely followed-up to maintain optimal adherence to medical treatments and to reduce adverse events. Digital health interventions might provide improved outcomes for patient care by providing closer follow- up, compared to standard care. Thus, in this meta-analysis, we aimed to evaluate the effect of digital health interventions on follow-up in acute coronary syndrome patients. We searched medical databases to obtain all relevant studies comparing digital health interventions with standard care in acute coronary syndrome patients. After reviewing all eligible studies, a meta-analysis was conducted with the remaining 11 randomized controlled studies and 2 non-randomized controlled studies. A modified Jadad scale and Newcastle-Ottawa scale were used to assess the quality of the publications for randomized controlled studies and non-randomized controlled studies, respectively. This meta-analysis consisted of 7657 patients. The all-cause mortality rate was 49% lower in the digital health intervention cases, compared to those who received standard care [relative risk (RR) = 0.51 (0.37; 0.70), P <.01]. There was a significant decrease in systolic blood pressure in the digital health interventions group, compared to the standard care group [mean difference = -5.28 (-9.47; -1.08), P =.01]. The rate of nonadherence to anti-aggregant drugs was 69% lower in the digital health interventions than in the standard care group [RR = 0.31 (0.20; 0.46), P <.01]. Also, nonadherence rates for statin and beta-blockers were lower in the digital health interventions group. The risk of rehospitalization was observed to be 55% less in the digital health interventions patients, compared to the standard care group [RR = 0.45 (0.30; 0.67), P <.01]. Digital health interventions can be effective in follow-up for secondary prevention in acute coronary syndrome patients.

Nanoscale insights into the local structural rearrangements of amyloid-β induced by bexarotene.

A better understanding of the abnormal protein aggregation and the effect of anti-aggregation agents on the fibrillation pathways and the secondary structure of aggregates can determine strategies for the early treatment of dementia. Herein, we present a combination of experimental and theoretical studies providing new insights into the influence of the anti-aggregation drug bexarotene on the secondary structure of individual amyloid-β aggregates and its primary aggregation. The molecular rearrangements and the spatial distribution of β-sheets within individual aggregates were monitored at the nanoscale with infrared nanospectroscopy. We observed that bexarotene limits the parallel β-sheets formation, known to be highly abundant in fibrils at later phases of the amyloid-β aggregation composed of in-register cross-β structure. Moreover, we applied molecular dynamics to provide molecular-level insights into the investigated system. Both theoretical and experimental results revealed that bexarotene slows down the protein aggregation process via steric effects, largely prohibiting the antiparallel to parallel β-sheet rearrangement. We also found that bexarotene interacts not only via the single hydrogen bond formation with the peptide backbone but also with the amino acid side residue via a hydrophobic effect. The studied model of the drug-amyloid-β interaction contributes to a better understanding of the inhibition mechanism of the amyloid-β aggregation by the small molecule drugs. However, our nanoscale findings need to meet in vivo research requiring different analytical approaches.

Perioperative Management of Dental Surgery Patients Chronically Taking Antithrombotic Medications.

The development of medicine is based not only on the introduction of new methods of treatment, but also on the use of increasingly effective drugs, including antithrombotic drugs. Drugs that inhibit the activity of platelets (antiplatelet and anti-aggregating drugs) and pharmaceuticals that inhibit the activity of plasma coagulation factors (anticoagulants) are used in antithrombotic therapy. In our daily practice we encounter patients who take chronic antiplatelet or anticoagulant drugs. However, more and more often we are dealing with patients who are treated with two antiplatelet drugs, an antiplatelet and an anticoagulant or even undergoing triple antithrombotic therapy. When preparing the patient for invasive craniofacial procedures, it should be assessed whether the temporary discontinuation of antithrombotic treatment due to the fear of excessive perioperative bleeding is justified and will not result in life-threatening thromboembolic complications. The authors discuss in detail the medications used in modern antithrombotic treatment and present a perioperative management procedure with a patient who takes l4 z of these medications chronically.

Influence of the Antithrombotic Therapy in the Healing of Simple Post-Extraction Sockets: A Randomized Clinical Trial.

Background: An adequate blood supply plays a leading role in the healing process of the post-extractive socket; its coagulation leads to fibrin clot formation, which acts as a physical barrier able to prevent postoperative bleeding and microbial infection. The purpose of this study was to evaluate the effectiveness of antiaggregant drugs in healing post-extraction sockets compared to natural wound healing. Methods: This was a single-center prospective clinical trial. Extraction sockets allocated in healthy patients and in patients assuming antiplatelet drugs were considered. Thirty consecutive patients under (treated with/in treatment with) oral antiplatelet treatment were enrolled in the test group. In order to provide a control group, 30 consecutive patients meeting all the exclusion and inclusion criteria were enrolled. The extraction of the mono-radicular tooth was atraumatically performed without gingivoplasty or osteotomy procedures that could influence the healing process. Photographs were obtained before and immediately after surgery and at 3-, 7-, 14- and 28-days follow-up. Results: All patients assumed the prescribed therapy and their post-operative recovery was uneventful without any kind of post-extractive complications. The results of inter-group comparison show that on the third and seventh days of follow-up, the antiplatelet group expressed a statistically significant higher level of healing compared to the control group (p < 0.05), while no statistically significant differences were recorded at 14- and 28-days follow-up. Conclusions: Patients treated with antiplatelet agents seemed to show that this therapy can positively affect the healing process after tooth extractions.

Accumulation of Deleterious Effects in Gastric Epithelial Cells and Vascular Endothelial Cells In Vitro in the Milieu of Helicobacter pylori Components, 7-Ketocholesterol and Acetylsalicylic Acid.

The Gastric pathogen Helicobacter pylori (HP) may influence the development of coronary heart disease (CHD). H. pylori induce reactive oxygen species (ROS), which transform cholesterol to 7-ketocholesterol (7-kCh), a CHD risk factor. Acetylsalicylic acid (ASA)—an Anti-aggregation drug used in CHD patients—may increase gastric bleeding and inflammation. We examined whether H. pylori driven ROS effects in the cell cultures of gastric epithelial cells (AGS) and vascular endothelial cells (HUVEC) progress in the milieu of 7-kCh and ASA. Cell cultures, exposed to 7-kCh or ASA alone or pulsed with the H. pylori antigenic complex—Glycine acid extract (GE), urease (UreA), cytotoxin associated gene A (CagA) protein or lipopolysaccharide (LPS), alone or with 7-kCh and ASA—were examined for ROS, apoptosis, cell integrity, interleukin (IL)-8, the activation of signal transducer, the activator of transcription 3 (STAT3), and wound healing. ASA and 7-kCh alone, and particularly in conjunction with H. pylori components, increased the ROS level and the rate of apoptosis, which was followed by cell disintegration, the activation of STAT3, and IL-8 elevation. AGS cells were unable to undergo wound healing. The cell ROS response to H. pylori components may be elevated by 7-kCh and ASA.

Strokes in children

Introduction and purpose A stroke is a group of neurological symptoms that develops when blood flow to the brain is stopped suddenly. Stroke is relatively rare in the group of pediatric patients. The incidence is estimated at 2.5 cases per 100,000 children per year. Mortality is up to 4%. Long-term consequences and complications concern more than half of the patients. Brief description of the state of knowledge The etiopathogenesis of stroke in children is diverse. The main risk factors are congenital heart disease, vascular damage, metabolic diseases and infections. The symptoms of a stroke depend on the location and extent of the ischemic changes. In children they may initially be uncharacteristic. The most common are headaches, vomiting, convulsions, disturbed consciousness, and hemiparesis. The gold standard in cerebral ischemia imaging is brain magnetic resonance angiography (MRA). In treatment controlling vital parameters plays an important role. Treatment includes anti-aggregating and anticoagulant drugs. It is possible to transfuze blood or surgical treatment. Complications of stroke in children are diversify and depend on a lot of factors. These include movement disorders, cognitive functions impairment, tension headaches and difficulty with expression and fluency of speech. Conclusion A stroke is a life-threatening condition that requires immediate treatment. It can have uncharacteristic symptoms in children. Acute cerebral ischemia in children carries the risk of developing long-term, severe complications. Pediatric patients with a history of acute cerebral ischemia should be under the constant care of specialized treatment and rehabilitation centers, which will enable patients to function independently among their peers.

Distribution and Transmembrane transport as the basis of proper Pharmacodynamics of an Antithrombotic drug – An Indolinone derivative

The goal of the present study: assess the distribution and transmembrane transport of an antiaggregant drug GRS of indolinone series. The distribution of an indolinone derivative in organs, between blood plasma and blood cells was studied in Sprague Dawley rats. A Thermo Scientific Pierce dialysis system was used to study the binding to blood plasma proteins. A MultiScreen Caco-2 test system was used to study the transmembrane transfer of the indolinone derivative. Quantitative assay of GRS was performed by an HPLC/МS method. GRS was shown to pass into the liver, heart and kidneys, and doesn’t pass into the brain and skeletal muscle. The highest GRS accumulation occurs in the liver, the lowest in the kidneys. GRS has low plasma protein binding and its concentration is 1.6 times higher in blood cells than in blood plasma. GRS in 1 mcmol concentration has low cell membrane permeability from apical to basolateral membrane (A-B), increasing the concentration gradient by 10 times leads to a corresponding increase in transport efficiency. In the reverse direction (B-A) GRS permeability is 8.8 times higher, showing its participation in active transport. Pgp inhibitor cyclosporin A considerably decreases the transport efficiency of GRS in B-A direction.

Perioperative Use of Anticoagulant and Antiaggregant Drugs; Approaches of Anesthesiology and Reanimation Physicians in Türkiye: A survey study

Abstract Objective: We aimed to assess the approach of Turkish Anesthesiology and Reanimation Specialists in patients receiving preoperative anticoagulant/antiaggregant therapy. A survey was designed to evaluate perioperative management of anticoagulant/antiaggregant drugs. Methods: We surveyed Anesthesiology and Reanimation specialists and residents in various hospitals in Türkiye through e-mail and smartphone messenger application. We asked them to complete questionnaire form regarding anticoagulant use on a voluntary basis between February 15 and March 15 in 2022. Results: The survey was responded by 296 anesthesiology specialists and residents. The majority of the participants (73.3%) were anesthesiology specialist physicians and work in 3rd level (academic, teaching, or university) hospital. The mostly used antithrombotic drugs were warfarin (75.9%) and acetylsalicylic acid (100%). Most of the participants (61%) use international guidelines regarding the timing of drug discontinuation. Participants commonly (82%) refer to the consultant specialist of the patient for deciding to discontinue or restarting the patient’s antithrombotic drug. The major perioperative concern about the antithrombotic drugs was bleeding complications of central neuraxial procedures (44.8%). Conclusion: The anesthesia and reanimation specialists in Türkiye manage antithrombotic drugs in accordance with international guidelines. The distribution ranges are wide in times of preoperative discontinuation and postoperative restarting times of the medications; thus, the awareness needs to be increased to clear up this controversy.

Is emergency gastrointestinal system tumor surgery safe under treatment of antitrombotics?

The use of antitrombotic (antiaggregant and anticoagulant) drugs is increasing all over the world and in our coun-try. About 12.6% of patients who underwent gastrointestinal tumor surgery receive antitrombotic therapy for various reasons, and in this study, we aimed to demonstrate the safe feasibility of elective or emergency gastrointestinal tumor surgery with the correct perioperative antitrombotic therapy management. The patients who were planned for gastrointestinal tumor surgery under antitrombotic treatment were analyzed in three groups as those whose pre-operative treatment management treatment was discontinued, those who underwent bridging treat-ment, and those whose treatment continued. Anti-embolic stockings or intermittent pneumatic compression devices were applied to all patients preoperatively and postoperatively as mechanical prophylaxis. Post-operative complications, especially post-operative bleeding and thrombosis, were evaluated using the Clavien-Dindo post-operative complication classification. When patients who were under antithrombotic therapy, whose therapy was discontinued, and who underwent surgery under bridging therapy, no significant difference was found between the three groups in terms of bleeding complications. In tertiary centers with high clinical experience, elective and emergency gastrointestinal system tumour surgery can be safely performed under antitrombotic therapy without increasing the thromboembolic risk.

Перспективы применения цилостазола в комплексном лечение больных облитерирующим атеросклерозом артерий нижних конечностей

Despite intensive study of pathophysiology, of molecular and cell mechanisms of progression of atherosclerosis, development and introduction of a wide range of new conservative and surgical treatment methods, until now the diseases of lower limb arteries (DLLA) are one of the most urgent problems of the modern vascular surgery and medicine in general. Intensive development of roentgen-endovascular methods of treatment for the diseases of lower limb arteries has led to a considerable revision of the tactics of management of this category of patients in the recent years. Despite the achievements of roentgen-endovascular surgery, frequency of obstructions after surgical revascularization of limbs remains high, both in early and late postoperative periods. It should also be noted that despite the intensive development of methods of therapy of patients with DLLA, frequency of limbs amputation in this category of patients remains high. One of the urgent problems of management of patients with DLLA after endovascular treatment is the problem of restenosis. In the recent years, new efficient methods of pharmacotherapy of DLLA have been developed and introduced into clinical practice, which allows significant improvement of medical prognosis in this category of patients and improvement of the outcomes. It should be noted that standard approaches to antithrombotic therapy in patients after endovascular surgeries based on use of antiaggregant drugs, can only decrease the rate of thrombotic complications, but not of restenosis, which, from the point of view of pathophysiology, is mainly hyperproliferative condition. Among promising approaches to treatment of restenosis, there is use of cilostazol, efficiency of which after endovascular surgeries on coronary and peripheral arteries has been proven in a number of studies.

Changes in cardiac cells due to ticagrelor and enoxaparin in a rat ischemia/reperfusion model.

Studies on ischemia/reperfusion injury remain the focus of interest. Ticagrelor and enoxaparin, which are antiaggregant and anticoagulant drugs developed for use in many cardiovascular pathologies, are still included in many ischemia/reperfusion studies. Remarkably, their new protective effects, especially with regard to ticagrelor, continue to be reported in the current literature. The aim of this study was to evaluate the beneficial effects of ticagrelor and enoxaparin pretreatments on the rat heart with histological and immunohistochemical markers in an ischemia/reperfusion model. Wistar-albino rats (weighing 350-400 g) were divided into four groups as follows: Sham-Control (Group 1), Control-Saline+ischemia/reperfusion (Group 2), Ticagrelor+ischemia/reperfusion (Group 3), and Enoxaparin+ischemia/reperfusion (Group 4). The ischemia/reperfusion injury model was applied to Group 2, Group 3 and Group 4. Heart tissue sections were stained with hematoxylin and eosin for histological examinations. Caspase 3 immunostaining was evaluated to detect apoptosis in the heart tissue sections. Both pretreatments ameliorated the ischemic damage but especially tissue sections belonging to Group 3 were nearly similar to control levels. The results indicated that ischemia/reperfusion-induced myocardial damage was significantly increased in Group 2, whereas ticagrelor and enoxaparin pretreatments in Group 3 and Group 4 significantly decreased apoptotic scores and the histological appearance of the Group 3 close to the normal myocardium (p<0.001). As supported by histological findings in our study, ticagrelor and enoxaparin have protective properties for heart tissue in this ischemia/reperfusion injury model.

Long-term prognostic outcomes in patients with haemoptysis

BackgroundHaemoptysis is a challenging symptom that can be associated with potentially life-threatening medical conditions. Follow-up is key in these patients to promptly detect new or misdiagnosed pathologic findings. Few prospective studies have evaluated long-term prognostic outcomes in patients with haemoptysis. Furthermore, the role played by antiplatelet and anticoagulant drugs on mortality and recurrence rates is unclear. The aim of this study was to assess mortality after 18 months of follow-up. Furthermore, the incidence of recurrence and the risk factors for recurrence and death were evaluated (including the role played by anticoagulant and antiplatelet drugs).MethodsObservational, prospective, multicentre, Italian study.Results451/606 (74.4%) recruited patients with haemoptysis completed the 18 months follow-up. 22/604 (3.6%) diagnoses changed from baseline to the end of the follow-up. 83/604 (13.7%) patients died. In 52/83 (62.7%) patients, death was the outcome of the disease which caused haemoptysis at baseline. Only the diagnosis of lung neoplasm was associated with death (OR (95%CI): 38.2 (4.2–347.5); p-value: 0.0001). 166 recurrences were recorded in 103/604 (17%) patients. The diagnosis of bronchiectasis was significantly associated with the occurrence of a recurrence (OR (95% CI): 2.6 (1.5–4.3)); p-value < 0.0001). Anticoagulant, antiaggregant, and anticoagulant plus antiaggregant drugs were not associated with an increased risk of death and recurrence.ConclusionsOur study showed a low mortality rate in patients with haemoptysis followed-up for 18 months. Pulmonary malignancy was the main aetiology and the main predictor of death, whereas bronchiectasis was the most frequent diagnosis associated with recurrence. Antiplatelet and/or anticoagulant therapy did not change the risk of death or recurrence. Follow-up is recommended in patients initially diagnosed with lower airways infections and idiopathic bleeding.Trial registration: NCT02045394